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477-000-045

REV. AUGUST 6, 2025 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY 477-000-045 – Share of Cost If an applicant or recipient of Nebraska Medicaid does not meet the requirements for Nebraska Medicaid due to excess income, but can demonstrate a medical need, then a medically needy budget may be approved. Countable income for the month is reduced to the Medically Needy Income Level (MNIL) by spending the excess income on medical services or supplies. The amount that needs to be incurred is referred to as the Share of Cost (SOC). Nebraska Medicaid becomes active for the month after an individual has reduced their income below the MNIL. Each month is determined separately. An applicant may be determined eligible for medical assistance with a SOC if: 1. The applicant’s income and resources have been verified. The individual must meet a category of eligibility except for excess income; 2. A medical need exists or can reasonably be anticipated which meets or exceeds the SOC amount; 3. The individual has paid or obligated the SOC for medical care or services for anyone in the medical assistance unit. If the income of a parent in the home but not in the unit has been considered in the budget, the parent’s medical expenses (including insurance premiums) may be applied to meet the child's SOC obligation; and 4. Obligations or expenditures are substantiated on the Record of Health Cost – Share of Cost – Nebraska Medicaid Program form. The medical need will be re-evaluated at renewal. If it is determined that a medical need continues to exist, and the applicant remains eligible, then a SOC benefit may continue. If it is determined that a medical need no longer exists or the SOC has not been met in the prior months, then the benefit will end. Meeting the SOC Obligation When it is necessary to obligate income to meet the SOC, a form will be mailed each month. The individual will take the monthly SOC form to medical providers and medical services received for the month will be recorded on the form. The medical provider that provides the last service necessary to meet the SOC will submit the completed SOC form as directed on the form. Nebraska Medicaid coverage for medical bills not used to meet the SOC obligation is effective at the first of the month. If the individual does not meet the obligation, no medical bills are paid by Nebraska Medicaid for that month.

Allowable Share of Cost Obligations Medical Service or Supply: Any medically necessary service or supply is an allowable obligation of the SOC amount, whether or not the service or supply would be covered by Nebraska Medicaid. This includes the cost of: • Transportation to obtain necessary medical care. Mileage is allowed if the person travels by car. The actual cost of other forms of transportation is allowed.